MixInYeast: A Multicenter Study on Mixed Yeast Infections

Abstract

Invasive candidiasis remains one of the most prevalent systemic mycoses, and several studies have documented the presence of mixed yeast (MY) infections. Here, we describe the epidemiology, clinical, and microbiological characteristics of MY infections causing invasive candidiasis in a multicenter prospective study. Thirty-four centers from 14 countries participated. Samples were collected in each center between April to September 2018, and they were sent to a reference center to confirm identification by sequencing methods and to perform antifungal susceptibility testing, according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST). A total of 6895 yeast cultures were identified and MY occurred in 150 cases (2.2%). Europe accounted for the highest number of centers, with an overall MY rate of 4.2% (118 out of 2840 yeast cultures). Of 122 MY cases, the most frequent combinations were Candida albicans/C. glabrata (42, 34.4%), C. albicans/C. parapsilosis (17, 14%), and C. glabrata/C. tropicalis (8, 6.5%). All Candida isolates were susceptible to amphotericin B, 6.4% were fluconazole-resistant, and two isolates (1.6%) were echinocandin-resistant. Accurate identification of the species involved in MY infections is essential to guide treatment decisions.

Species distribution, azole resistance and related molecular mechanisms in invasive Candida parapsilosis complex isolates: Increase in fluconazole resistance in 21 years

“…Recent studies underlined the importance of mixed infections in fungemia, which can cause inappropriate treatment and a worse outcome. 39,40 This phenomenon might raise concerns for C. parapsilosis complex infections, as different members of the species complex might co-exist during a fungemia episode. Barbedo et al 41 detected polyfungal infections involving C. parapsilosis sensu stricto and C. orthopsilosis in 9.5% of the fungemia episodes caused by C. parapsilosis complex.…”

“…Recent studies underlined the importance of mixed infections in fungemia, which can cause inappropriate treatment and a worse outcome 39,40 . This phenomenon might raise concerns for C. parapsilosis complex infections, as different members of the species complex might co‐exist during a fungemia episode.…”

Antifungal Resistance in Clinical Isolates of Candida glabrata in Ibero-America

“…With respect to other azoles, itraconazole ranked second in Ibero-America as the azole to which the clinical isolates of C. glabrata are most frequently resistant, in contrast to what has been reported in studies with isolates of C. glabrata from other countries, where the rates of resistance to fluconazole and itraconazole have been reported to be similar [53].…”

T2Candida for the Diagnosis and Management of Invasive Candida Infections

“…Further studies in patients with invasive candidiasis are needed to validate and quantify the effect of T2Candida-based management strategies on outcomes, including mortality, length of stay, and duration of antifungal therapy. A recent multicenter study isolated mixed yeast infections in approximately 2% of cultures from sterile sites [47]. The paired reporting of T2Candida results (i.e., C. albicans/ C. tropicalis and C. glabrara/C.…”